Mandate Realists

09Nov

Last week, I wrote about what might happen if the Supreme Court struck down the individual mandate portion of the Affordable Care Act, leaving the rest of the law intact. It seems that others have been chiming in to, and if I interpreted the Lewin Group’s study in Health Affairs through a “glass half-full” lens, others aren’t convinced and certainly aren’t optimistic.

One of the cynics (realists?) is Mark Hall, who I know and admire. He has a well-written article critiquing the Health Affairs piece, where else but the Health Affairs blog. In his post, he does an excellent job of explaining why Lewin’s research is an outlier and why we should put more stock in the doomsday predictions of Jonathan Gruber and friends. He also puts forward a sort of Pascal’s Wager in support of the mandate: We don’t know how bad things will be without a mandate, but we do know that things won’t be bad with the mandate, so better to make the safe bet. I actually agree with all of this, with one exception: It ignores the case of the status quo, which I think is worse than all the other elements of health reform minus the individual mandate, which is itself worse than all of the elements of health reform including the individual mandate.

I’m all for the individual mandate, I’m just not ready to throw in the towel if that single piece of the law takes a hit. For more on how there’s “no ‘silver lining’ in repealing [the] insurance mandate” check out this excellent piece from Naomi Freundlich at Health Beat.